Owning an in-person vs. virtual practice

Once you have decided to start your own counseling practice, a natural next step is to decide whether it will be an in-person or virtual business. Since the COVID-19 pandemic, many virtual counseling practices have opened — which allow counselors to meet clients remotely from their own homes.

The decision to establish traditional roots with a physical office location or adapt to a modernized virtual-only practice is an important one because it heavily impacts the type of services you can offer and the financial profit you can expect. Considering the positives and negatives of each type of practice will help you make a solid choice.

Let’s take a closer look at the pros and cons of having an in-person practice.

A primary asset of owning an in-person practice is your ability to meet clients in an intimate and private setting. Rather than relying on clients to establish their own confidential and comfortable environment, you can guarantee their privacy in your personal office. 

The value of privacy cannot be overstated because you cannot ensure total confidentiality when your client is physically apart from you, as is the case with virtual sessions. This provision is particularly useful if you work with clients whose privacy can be compromised, such as child clients whose parents are at home or an adult client whose spouse has inconsistent work hours.

Another plus of owning an onsite location is the opportunity to more thoroughly assess your clients’ well-being. While meeting clients face-to-face, you can observe their overall dress and posture and more clearly notice nonverbal cues, including shifts in mood, eye contact, and tone of voice.

These abilities make it easier for you to track clients’ emotional states and their motivation for change. The extra work required of clients to meet you in person also increases their investment in sessions since they must leave their home, work, or school in order to travel to you.

Additionally, offering in-person services gives you the chance to utilize more therapy interventions, including art, sand tray, and play therapy. These treatment modalities require supplies that many clients do not have at home or know how to use therapeutically, such as canvases and paints, jewelry-making materials, and kinetic sand. 

Likewise, while couples counseling and family therapy can be conducted virtually, the experience is far more comfortable for clients when it is conducted in a neutral location. For instance, if tensions flare and arguments break out between family members during an in-person session, you are physically there to help them de-escalate.

The risks of an in-person practice must be aptly weighed against its advantages, however. For starters, the overhead costs of owning an onsite location can be incredibly burdensome to your finances. There are many monthly bills to pay, like rent, phone, water, and internet, along with annual payments for cyber software and business websites. 

Inevitably, spontaneous needs will arise — whether in the form of new purchases or replacements — and must be swiftly addressed (i.e., printers, computers, therapy supplies, office décor). The amount of these costs can quickly surmount your profit and leave your business in the red.

Commute time is also important to consider in your decision to open an in-person practice because it costs not only fuel but also time, which you could be devoting to clients. Depending on the traffic in your area, it may take you longer than expected to arrive at work some days.

Late arrival can result in you feeling flustered as you begin sessions, particularly if you have an early morning client or need to set up supplies for expressive therapies. Similarly, a lengthy commute at the end of your workday can intensify feelings of fatigue and pave the way for burnout.

Often minimized by counselors, burnout is an escalated risk for in-person practice owners. When we are onsite with clients, it is easier to co-experience their strong emotions and negative thinking styles.

Similarly, we can more quickly agree to onsite clients’ supplementary requests without regard to our own commitments (i.e., staying 45 minutes after our last session to finish a client’s Family and Medical Leave of Absence paperwork despite having dinner plans with our spouse). Besides burnout, this exposure contributes to our increased vulnerability to compassion fatigue and secondary trauma — all of which can deteriorate the quality of our services.

Now let’s examine the pros and cons of a virtual practice.

Telehealth, the term used for counseling appointments offered through virtual means, is an alternative to the traditional in-person practice and has many advantages to offer practitioners. For instance, counselors can better understand their clients with the backdrop of their personal lives rather than the presentation they give in an office setting.

Clients can meet counselors from their homes in which they feel more comfortable. This low-stress environment can decrease clients’ guardedness and result in their provision of more honest and genuine feedback.

On a similar note, virtual practices drastically lower the rate of clients’ no-show/late cancellation rates. Telehealth makes attendance much simpler for clients since they need only click a button to start their session. Clients can schedule appointments that fit better into their schedules, such as while they are on a work break or after putting their children to bed. 

This freedom can result in increased booking by clients since they may be able to meet more frequently (i.e., a client who cannot leave work for in-person appointments may be able to meet weekly for evening virtual appointments or during their lunch hour). You can also continue offering sessions to clients who travel or move within the same state, such as a client who just graduated high school and wants to continue meeting with you during their college transition.

Yet another bonus of telehealth work is counselors’ ability to increase available work hours since meeting clients is as easy as turning on the computer or making a phone call. Rather than rushing to set up art materials or clean sand tray tables in preparation for the next client, counselors can open more appointment times for clients. Telehealth also reduces overhead business costs since counselors need to purchase fewer therapy supplies and office equipment for their virtual sessions.

Create high-quality video visits, group appointments, dedicated provider URLs, virtual waiting rooms, and custom patient communications with Tebra’s HIPAA- and HITRUST-certified telehealth.

Despite its appearance of being a simpler practice model, though, a completely virtual practice is accompanied by its own challenges. For example, counselors are less able to sense clients’ emotions because they are more camouflaged by technology.

This hindrance can result in counselors’ continued pursuit of sensitive topics with clients about which they are resistant but do not speak up. In order to compensate for this deficit, counselors can end up spending more of their mental and emotional energies trying to identify clients’ nonverbal cues than they do with in-person clients.

A major weakness of virtual-only practices is the unpredictability of telehealth equipment. Phone and video calls can end abruptly due to poor connections, which can inhibit the therapeutic process.

This vulnerability poses a great risk if counselors are working with clients in distress. Consider the ramifications of an internet malfunction that unexpectedly ends a session with a client who just voiced suicidal thoughts.

Potentially the most significant downside of virtual practices, though, is counselors’ inability to assure full privacy for their clients’ sessions. Since they have no regulation of clients’ environments, counselors must rely on their clients to create a confidential space during their sessions. They must anticipate that other individuals could interrupt clients’ sessions, whether family members or coworkers, and overhear sensitive information.

After reviewing the details of both practice types, you may still be unsure which route to choose. Asking yourself these questions can help clarify things.

My own answers to these questions led me to choose the fully virtual route when I opened my private practice. At the time, my daughter was still an infant, so I knew my time at home was particularly precious. I wanted to limit my work hours to active sessions with clients, not extend them unnecessarily with lengthy commutes or additional hours at an office. 

Uncertain of how my next few years would look as a new parent, I was disinterested in committing to rental contracts and addressing onsite problems. I didn’t plan on hiring additional staff members nor did I care to devote large sums to office and therapy supplies. After 2 years of operating a successful practice, I know I made the right choice based on the factors involved.

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Thanks to many technological advances and the COVID-19 pandemic, more counselors than ever before are opening virtual practices. Both in-person and virtual-only practices offer many perks and challenges for counselors. Weigh the pros and cons of each option before proceeding with your plans for private practice.